SCOTLAND is testing out a pioneering system of healthcare developed in the remote American state of Alaska.
The Nuka model of care is run for Alaskan native and American Indian people by a state-funded health system.
It involves dedicated teams of GPs, nurses and other health professionals such as psychologists and dieticians providing care for a small list of patients.
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There is also an emphasis on education and training in the community and traditional Alaska Native healing is offered alongside health and social care services.
The system, which was developed in the 1990s, has resulted in a 36 per cent reduction in days spent in hospitals and slashing emergency cases by 42 per cent, according to report by health think-tank The King’s Fund.
The Southcentral Foundation, which runs the Nuka model, is also said to have transformed healthcare for Alaska native people from “among the worst in the United States to among the best in the world” over three decades.
Now trials are taking place in Scotland of elements of Nuka, backed by the Scottish government, as part of the major drive towards the integration of health and social care services.
The pilots range from setting up small teams of mixed health professionals in GP practices to looking after patients to ‘social prescribing’ initiatives offering health-related activities such as dance classes and cookery clubs.
Maxine Jones, primary care development adviser with Scottish-based think-tank International Futures Forum, who visited Alaska in 2012 to see the Nuka model in action, said she believed it could work for Scotland.
“The focus [for Nuka] has been very much on putting the patient first and developing the service according to what the patient thinks, as opposed to what the health professionals think,” she said.
“They have a tag – it is all about relationships, so everything that happens is geared towards optimising relationships, both between the patient and care providers and also among the care providers themselves.”
Jones said in the Nuka model there was a comprehensive team, including a GP, nurse, healthcare assistant and administrator, looking after a list of 1,400 patients. She said this was a relatively small number compared to the current GP practice size in Scotland of around 1,800 and upwards per each full-time doctor.
“Because the teams are dealing with relatively few patients, they are able to give patients the time they need, so they are able to do things like care and support planning and helping people with wellness as well as illness issues,” she said.
Jones said the model could work for Scotland and was already being tested out, but cautioned it would take some time to evolve north of the border.
She added: “I believe it could provide the solution to the crisis in primary care currently.
“However there are significant barriers to overcome – for example, it is very hard for practices to be able to only see 1,400 patients per whole-time equivalent GP. That is unheard of amidst a GP recruitment crisis.
“One of the beauties of Nuka is it has a whole range of extended services available where people can be sent immediately, whereas most practices here maybe have a physiotherapist, for example, that comes in once a week.
“It would need to be a lot more comprehensive.”
Andrew Strong, assistant director of policy and communications at the Health and Social Care Alliance Scotland, which represents health and social care organisations, said models such as Nuka should be tested out as part of the integration of health and social care services.
He said: “What we need to do is look at giving these ideas the air and oxygen to be built on. I don’t think there has been enough of that yet.
“There are lots and lots of new ideas and lots of innovation going on in health and social care but what we need really is more investment and more time and monitoring and evaluation put into these things to make them happen.”
Shona Robison, cabinet secretary for health and sport, said the government’s national clinical director, Professor Jason Leitch, has been working closely with Nuka experts and exchanging visits and ideas.
She added: “The roots of their system are integrated healthcare social care and mental health, with a very strong emphasis on patient and family involvement in care decisions. Presently we are testing various elements of this in Scotland.”